Objective To study the clinical presentations,radiologic features,prognosis,and possible causes of liver injury associated umbilical venous catheter (UVC ).Methods We reviewed database of our NICU from December 2012 to November 2015 and identified preterm infants with liver injury while UVC in place.The gestational age,birth weight,gender,days of UVC in place prior to liver injury, the depth of UVC (cm),UVC tip position,ultrasound findings of liver injury,laboratory tests,treatment and outcomes were collected.Results During study period,322 infants received UVC insertion.Ten cases (3.1 %)of liver injury associated with UVC were diagnosed.Of the ten infants,nine were diagnosed as extravasation of fluid to liver parenchyma,and one was diagnosed as liver hematoma.The mean birth weight was (1184 ±207)g,mean gestational age was (28.5 ±1.7)weeks.The UVC tip was at thoracic (T) vertebrae T 9 to T 11 level,nine UVC tips were below the right diaphragm level.All UVCs were used for total parenteral nutrition before liver injury was diagnosed.Six infants had clinical manifestations,and four infants were free of clinical manifestations.The most prominent clinical signs were abdominal distension (n =5),weak bowel sounds (n =5)and hepatomegaly (n =4).One infant who was diagnosed with liver hematoma also had progressive hemoglobin decline (minimum 34 g/L)and shock.Abdominal ultrasound showed well-limited,irregular,hyperechoic rimmed lesions with heterogeneously hypoechoic centers or anechoic liquid dark space.Extravasation of fluid to liver parenchyma will restorate within one week after the UVC was remove.One baby who was diagnosed as liver hematoma passed away at 9 days of life.Liver ultrasound of eight returned to normal in 52 days to 3.5 months,and one had calcified lesions at 9 months of age.Conclusions Liver injury is an unusual complication of UVC insertion and usage.Proper positioning of the UVC tip may help to avoid this complication.Early recognition,prompt diagnosis with liver ultrasound examination and timely treatment can lead to better outcome in newborns with extravasation of fluid to liver parenchyma.

OBJECTIVE: To explore the effect of delta-opioid receptor (DOR) in electroacupuncture (EA) protecting the brain against acute ischemic injury. METHODS: Fifty-one rats were randomly divided into sham ischemia group, ischemia group, sham EA group, EA group, and EA+DOR antagonist (naltrindole) group. Transient focal cerebral ischemia (1 hour) was induced in rat brain by middle cerebral artery occlusion (MCAO) method. EA was applied on Shuigou (GV 26) and Neiguan (PC 6) for 30 min, starting immediately after the onset of reperfusion. Neurological deficit scores and volume of cerebral infarction were detected after 24-hour reperfusion. Other 12 rats were randomly divided into sham ischemia group, ischemia group, EA group and EA + naltrindole group. DOR protein expressions were assessed by Western blotting after 24-hour reperfusion. RESULTS: In comparison with the ischemia group and sham EA group, EA significantly reduced ischemic infarction and neurological deficits (P<0.05); EA significantly increased the expression of 60 kD DOR protein (P<0.05) and tended to increase that of 36 kD DOR protein (P>0.05). When naltrindole was combined with EA, the naltrindole completely abolished the EA-induced protection in ischemic infarction and neurological deficits, and also arrested the expression of DOR. CONCLUSION: EA can up-regulate DOR expression and protect the brain from ischemia-reperfusion injury.

OBJECTIVETo observe the effect of natural type ginsenoside Rg2 (Rg2) and its stereoisomers [20 (R)-Rg2 and 20 (S)-Rg2] at different concentrations on oxygen-glucose deprivation/ reperfusion (OGD/R) induced cortical neuronal injury model in vitro, and to explore the mechanism, and compare their differences of action.

METHODSCortical neurons after 7-day culture were randomly divided into 5 groups, i.e., the control group, the model group, the Rg2 group, 20 (R) -Rg2 group, and 20 (S) - Rg2 group. Cortical neurons in the Rg2 group, 20 (R)-Rg2 group, and 20(S)-Rg2 group were pretreated with 20, 40, and 80 μmol/L Rg2, 20 (R) -Rg2, and 20 (S) -Rg2 for 24 h to prepare OGD/R model. The cell survival rate, the activity of Caspase-3, the intracellular Ca2+ concentration, contents of superoxide dismutase (SOD) and malondialdehyde (MDA) were detected 24 h later.

RESULTSCompared with the control group, cell survival rates and activities of SOD obviously decreased, the activity of Caspase-3, Ca2+ fluorescent optical gray value, and contents of MDA significantly increased with statistical difference (P < 0.05). Compared with the model group, cell survival rates and activities of SOD obviously increased, the activity of Caspase-3, Ca2+ fluorescent optical gray value, and contents of MDA significantly decreased in 20 μmol/L Rg2 group, 40 μmol/L 20 (R) -Rg2 group, and 80 μmol/L 20 (S) -Rg2 group (P < 0.05). Compared with 20(S)-Rg2 group, cell survival rates increased and contents of MDA significantly decreased in 20, 40, and 80 μmol/L Rg2 and 20 (R)-Rg2 groups (P < 0.05). The activity of Caspase-3 decreased and contents of SOD increased in 80 μmol/L 20 (R)-Rg2 group, and 40, 80 μmol/L Rg2 groups (P < 0.05). Ca2+ fluorescent optical gray value decreased in 40, 80 μmol/L Rg2 and 20 (R)-Rg2 groups (P < 0.05). Compared with 20 (R)-Rg2 group, Ca2+ fluorescent optical gray value decreased in 80 μmol/L Rg2 group (P < 0.05); contents of SOD increased in 40 and 80 μmol/L Rg2 groups (P < 0.05); contents of MDA decreased in 20, 40, and 80 μmol/L Rg2 groups (P < 0.05).

CONCLUSIONSRg2 and its stereoisomers could improve cell vitality of cortical neurons against OGD/R induced injury. This might be related to improving anti-apoptotic capacities and antioxidant abilities, and reducing Ca2+ inflow. Besides, the neuroprotective effect of 20 (R) -Rg2 was better than that of 20 (S) -Rg2, but inferior to that of Rg2.

Antioxidants ; metabolism ; Apoptosis ; Calcium ; metabolism ; Caspase 3 ; metabolism ; Cell Survival ; Cells, Cultured ; Ginsenosides ; pharmacology ; Glucose ; Humans ; Malondialdehyde ; metabolism ; Neurons ; drug effects ; Neuroprotective Agents ; pharmacology ; Oxygen ; Random Allocation ; Reperfusion Injury ; Stereoisomerism ; Superoxide Dismutase ; metabolism

OBJECTIVETo evaluate the safety and the clinical value of external use of jiuyi Powder (JP) in treating plasma cell mastitis using partial least-squares discriminant analysis (PLSDA).

METHODSTotally 50 patients with plasma cell mastitis treated by external use of JP were observed and biochemical examinations of blood and urine detected before application, at day 4 after application, at day 1 and 14 after discontinuation. Blood mercury and urinary mercury were detected before application, at day 1, 4, and 7 after application, at day 1 and 14 after discontinuation. Urinary mercury was also detected at 28 after discontinuation and 3 months after discontinuation. The information of wound, days of external application and the total dosage of external application were recorded before application, at day 1, 4, and 7 after application, as well as at day 1 after discontinuation. Then a discriminant model covering potential safety factors was set up by PLSDA after screening safety indices with important effects. The applicability of the model was assessed using area under ROC curve. Potential safety factors were assessed using variable importance in the projection (VIP).

RESULTSUrinary β2-microglobulin (β2-MG), urinary N-acetyl-β-D-glucosaminidase (NAG), 24 h urinary protein, and urinary α1-microglobulin (α1-MG) were greatly affected by external use of JP in treating plasma cell mastitis. The accuracy rate of PLSDA discriminate model was 74. 00%. The sensitivity, specificity, and the area under ROC curve was 0. 7826, 0. 7037, and 0. 8084, respectively. Three factors with greater effect on the potential safety were screened as follows: pre-application volume of the sore cavity, days of external application, and the total dosage of external application.

CONCLUSIONSPLSDA method could be used in analyzing bioinformation of clinical Chinese medicine. Urinary β2-MG and urinary NAG were two main safety monitoring indices. Days of external application and the total dosage of external application were main factors influencing blood mercury and urine mercury. A safety classification simulation model of treating plasma cell mastitis by external therapy of JP was established by the two factors, which could be used to assess the safety of external application of JP to some extent.

Acetylglucosaminidase ; Alpha-Globulins ; Discriminant Analysis ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Least-Squares Analysis ; Mastitis ; drug therapy ; Plasma Cells ; ROC Curve ; Safety

OBJECTIVETo evaluate the mechanical load of retropalatal airway in obstructive sleep apnea patients, and to investigate the contributions of pharyngeal anatomy to upper airway collapsibility.

METHODSStatic mechanical load of transpalatal pharynx was determined by opening pressure (Popen) of the segment during general anesthesia in 30 patients and 14 controls. Size of pharynx was measured while intraluminal pressure was controlled at 3-20 cm H2O (1 cm H2O = 0.09806 kPa) and the minimal intraluminal pressure that needed to compensate for the mechanical load of a retropalatal segment was determined.

RESULTSPharyngeal cavity collapse at the level of the hard palate was observed in only one of the 30 subjects (3.3%), and in none of the 14 controls. At tongue base level, 23 subjects had a Popen > 0 cm H2O (76.7%) while in 7 of the controls (50.0%) had a Popen > 0 cm H2O. And at the level of the uvual and soft palate, pharyngeal collapses was observed in all subjects except in 9 of the controls (64.3%). The median of Popen was 8.3 [5.9;11.5] cm H2O in the patients group and was 2.7 [-3.9;6.0] cm H2O in the control group. Differences of Popen were significant between patients and controls (U = 58.500, P = 0.000). The correlation between Popen and AHI was also significant at 0.05 level (r = 0.377, P = 0.044).

CONCLUSIONSPatients with sleep apnea have more collapsible passive upper airway than controls. Retropalatal and retroglossal airway are the most collapsible segments and positive pressures are needed to compensate for the mechanical loads.

Adult ; Case-Control Studies ; Female ; Humans ; Middle Aged ; Muscle Relaxation ; Palate, Soft ; anatomy & histology ; physiology ; physiopathology ; Pharyngeal Muscles ; physiology ; Pressure ; Sleep Apnea, Obstructive ; etiology ; pathology ; physiopathology ; Tongue ; anatomy & histology ; physiology ; Young Adult

OBJECTIVETo isolate, identify and culture human spermatogonial stem cells (SSC) and then obtain purified and enriched human SSCs for research and application.

METHODSWe detected the expression of CD90 in the human testis using the immunofluorescence technique and isolated human testicular spermatogenic cells by two-step enzymatic digestion, followed by differential plating and magnetic-activated cell sorting (MACS) with CD90 as an SSC marker. Then we identified the isolated CD90-positive spermatogenic cells by RT-PCR and immunocytochemistry, and meanwhile cocultured them with Sertoli cells in SG medium in vitro.

RESULTSThe isolated CD90-positive cells showed a relatively homogeneous characteristic in size and morphology and expressed the genes specific for human SSCs, with high expressions (90.5%) of GFRA1, GPR125, and UCHL1. After coculture with Sertoli cells in the SG medium for 2 weeks, the isolated CD90-positive cells maintained a good activity.

CONCLUSIONCD90 can be regarded as a speci- fic marker for human SSCs and used to obtain highly enriched human SSCs by differential plating and MACS. Furthermore, the isolated human SSCs can be cultured in SG medium in vitro.

Adult Stem Cells ; cytology ; Biomarkers ; metabolism ; Cell Separation ; methods ; Cell Shape ; Cell Size ; Coculture Techniques ; Glial Cell Line-Derived Neurotrophic Factor Receptors ; metabolism ; Humans ; Immunohistochemistry ; Male ; Receptors, G-Protein-Coupled ; metabolism ; Sertoli Cells ; Spermatogonia ; cytology ; Testis ; metabolism ; Thy-1 Antigens ; isolation & purification ; metabolism ; Ubiquitin Thiolesterase ; metabolism

Objective:To study the characteristics of neonatal fungal sepsis and the difference between bacterial sepsis and fungal sepsis.To improve the understanding of neonatal fungal sepsis.Methods:Clinical data of neonatal fungal sepsis in neonatal intensive care unit (NICU) were collected from 2011 to 2016 in Peking University first Hospital.The clinical characteristics were analyzed retrospectively.The difference between neonatal fungal sepsis and bacterial sepsis was also analyzed.Results:Fifteen cases of neonatal fungal sepsis were recruited.Over the study period,the incidence of neonatal fungal sepsis was 0.52％,while it was 2.5％ in very low birth weight infants.Clinical characteristics were nonspecific.All the infants were treated with parenteral nutrition and broad spectrum antibiotics.Peripheral inserted central catheter (PICC) was placed in thirteen patients.Pathogenic analyses indicated Candida glabrata was the main pathogen in our study.All the pathogens were sensitive to amphotericin B.Only one Candida glabrata was resistant to fluconazole.Thirty-four cases of bacterial sepsis were included.The clinical characteristics and laboratory examination results were compared.The platelet count was 61 × 109/L in fungal group,while the platelet count was 178 × 109/L in bacterial group.There was statistical difference between the fungal group and bacterial group (P =0.004).The rate of thrombocytopenia was 80.0％ in fungal group,while it was 29.4％ in bacterial group.It was much higher in fungal group than in bacterial group (P =0.001).The rate of PICC placement was 86.7％ in fungal group,while it was 55.7％ in bacterial group.It was much higher in fungal group than in bacterial group (P =0.037).Receiver operating characteristic (ROC) curve analysis showed that the cut-off value of the platelet count for the diagnosis of neonatal fungal sepsis was 145 × 109/L (sensitivity 61.8％,specificity 92.9％).All the patients were cured after standardized antifungal therapy.The indicators of liver and renal function were also measured before and after antifungal therapy.No significant difference was observed before and after treatment.Conclusion:The clinical characteristics of neonatal fungal sepsis was nonspecific.Candida glabrata was the main pathogen in our NICU.It can be cured as the result of standardized treatment.Decreased platelet count and PICC placement may indicate the possibility of fungal sepsis in neonates.

Objective To study the influence of continuous blood purification(CBP) on cardiac out-put of pediatric patients using bioreactance. Methods Patients underwent CBP in PICU and nephrology ward from March 2014 were prospectively enrolled after approval by ethics committee. CBP therapies were all performed by Fresenius Medical Care hemodialysis machine. Cardiac output values were obtained using the non-invasive cardiac output monitoring ( NICOM) device ( Cheetah Medical). Blood pressure, heart rate, cardiac index(CI) and stroke volume index(SVI) were recorded before the therapy,at the beginning of ther-apy,during the course of therapy,and at the end of each therapy. Results Twenty-one pediatric patients (from 1. 0 year to 15. 5 years) were recruited and 69 treatments were recorded from March 2014 to Decem-ber 2016. The basic CI was 3. 4 (2. 4,6. 1) L/(min·m2),basic SVI was 43 (26,75) ml/(m2·beat). Dur-ing the beginning of therapy,mean arterial pressure(MAP),CI and SVI all dropped from the baseline ( P<0. 001),whereas heart rate increased. During the course of CBP,CI and SVI (were both recorded every 4 hours) kept on dropping and stayed at a relatively lower level. Course CI was 3. 0 (2. 4,4. 6) L/(min·m2) and course SVI was 28 (21,57) ml/(m2·beat). At the end of therapy,CI was 3. 4 (2. 5,5. 3) L/(min· m2),with no significant difference from the baseline CI (P＝0. 073). However,the SVI at the end of therapy was 35 (25,67) ml/(m2·beat),higher than the course SVI but still lower than the basic SVI,the differences were statistically significant ( P<0. 05). Conclusion CI and SVI continue to decline at the beginning of CBP treatment and remain at a lower level throughout the course of treatment. After the therapy, CI has returned to the basic level whereas SVI has not recovered.

Objective To study the early physical growth pattern,catch-up growth situation,and the influencing factors of early growth in small for gestational age (SGA) preterm infants.Method Our study was a single center,retrospective study.Criteria for infant inclusion were prematurity,SGA (birth weight less than the 10th percentile of related gender and gestational week,according to Fenton curve 2013),born between January 2012 to October 2015,admitted to our neonatal intensive care unit (NICU) within 24 h after birth,hospitalization more than 7 days,and discharged with complete oral feeding.Corrected age (CA) was used to evaluate growth.According to our follow up plan,anthropometric data (weight,length,head circumference) were collected at corrected full term (40 ± 4 weeks),CA (3 ± 1.5) months and CA (6 ± 1.5) months.Catch-up growth was defined as ΔZ greater than 0.67 compared with that at birth,successful catch-up was defined as anthropometric data higher than 10th percentile in target population.The characteristics and influencing factors were compared between infants with and without catch-up growth.Result Eighty-one SGA preterm infants were involved,45 boys and 36 girls.The average gestational age was (34.6 ± 1.7) weeks,birthweightwas(1617 ± 348) g,birthlengthwas(41.0 ±3.2)cm and head circumference was (29.7 ± 2.0) cm.At corrected gestational age (40 ± 4) weeks,CA (3 ± 1.5) months and CA (6 ± 1.5) months,follow-up rate was 86.4％,66.7％ and 58.0％;catch-up growth in weight was 32.9％,55.6％ and 66.0％;successful catch-up growth in weight was 52.9％,64.8％ and 66.0％.At CA (40 ±4) weeks,there were more boys,sooner recover birth weight,and less patent ductus arteriosus (PDA) in catch-up infants (P ＜ 0.05).At CA (3 ± 1.5) months,catch-up infants had large gestational age,and they were longer at discharge,shorter hospital stay,less PDA,and greater body weight at CA 40 weeks,the difference was statistically significant (P ＜ 0.05).At CA (6 ± 1.5) months,there were difference in hospitalization days,percentile of body weight at CA 40 weeks and percentile of all three anthropometrics at CA (3 ± 1.5) months between catch-up and no catch-up growth infants (P ＜ 0.05).Multiple factor analysis showed that percentile of weight at CA 3 months was the independent risk factor of catch-up growth in weight at CA 6 months (P =0.002,OR =1.221,95％ CI 1.076 ～ 1.385).For every 5 percentile increase in body weight percentile at CA (3 ± 1.5) months of age,the likelihood of complete body weight catch-up growth at CA (6 ± 1.5) months increased 2.965 times (95％ CI 1.480 ～ 5.942).Conclusion Both weight and length of SGA preterm infants showed a trend of rapid gain between corrected gestational age (40 ± 4) weeks to CA (3 ± 1.5) months.The factors that influencing the completion of catch-up growth are different at different age.The weight,length,and head circumference percentile at CA about 3 months are good predictors of growth pattern and situation at CA 6 months for the SGA preterm infants.

Objective:To investigate the incidence of hypothyroxinemia in very low birth weight infant (VLBWI) and its effect on early postnatal feeding and weight gain.Methods:This retrospective study analyzed 164 cases of VLBWIs admitted to the Neonatal Intensive Care Unit of Peking University First Hospital from January 2017 to December 2018. According to the gestational age, these VLBWIs were divided into <30 weeks group ( n=85) or ≥30 weeks group ( n=79), and the basic data and thyroid function were compared. According to the levels of serum tetraiodothyronine and free tetraiodothyronine at the first thyroid function test, the subjects were further assigned into normal thyroxine group and hypothyroxinemia group. The risk factors of hypothyroxinemia identified at the first detection were analyzed by single and multiple-facter analysis. The results of the second detection of thyroxine were also analyzed. On the basis of the first detection and receiving treatment or not, the <30 weeks and ≥30 weeks groups were divided into normal thyroxine, hypothyroxinemia treated and hypothyroxinemia untreated subgroups, and differences in the tolerance of early feeding and weight gain were compared between different groups. Two independent samples/paired t-test, rank sum test, Chi-square test and logistic regression were used for statistical analysis. Results:Out of the 164 VLBWIs with the gestational age of (29.7±2.0) weeks and birth weight of (1 210±210) g, 27 cases (16.5%) were extremely low birth weight infants. The age at their first detection was (10.7±3.1) d and the incidence of hypothyroxinemia was 45.1% (74/164), including 71 mild and three severe cases, with a higher incidence in the ≥30 weeks group comparing to the <30 weeks group [55.7%(44/79) vs 35.5%(30/85), χ 2= 6.883, P=0.009]. All the three severe cases were in the ≥30 weeks group. The gestational age ( OR=1.413, 95% CI:1.044-1.912, P=0.025) and male infant ( OR=2.082, 95% CI: 1.047-4.143, P=0.037) were the risk factors of hypothyroxinemia. At the second detection, the incidence of hypothyroxinemia in VLBWIs with normal thyroid function at their first test was 47.6% (39/82), which is higher in the ≥30 weeks group than in the <30 weeks group [64.5%(20/31) vs 37.3%(19/51), χ 2= 5.745, P=0.017]. Among the infants with hypothyroxinemia at the first detection, those untreated had a significantly higher incidence of hypothyroxinemia at the second detection than those treated [81.3%(26/32) vs 38.7%(12/31), χ 2= 11.905, P=0.001]. The incidence of abdominal distension within 21 days, feeding volume on day 7, 14, and 21, and neonatal weight gain within 7, 14, and 21 days were similar between normal thyroxine, hypothyroxinemia treated and hypothyroxinemia untreated subgroups within the ≥30 weeks or the <30 weeks groups (all P>0.05). Conclusions:VLBWI is at high risk of hypothyroxinemia. Two times of postnatal thyroid function tests can help to detect the delayed hypothyroxinemia. Thyroxine level and receiving treatment or not may have no significant effect on the early postnatal feeding and weight gain.